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The two Dr. Zics

Posted by on Tuesday, November 2, 2010 in Features, November 2010.

Conventional wisdom says never to look a gift horse in the mouth, but on a normal day seeing patients in the clinic, John Zic, M.D., found himself staring down at a literal gift horse, not quite sure how to react.

His patient Beth McDaniel and her husband, Roger, had just proudly presented Zic with a manila envelope. Inside he found a glossy 8×10 photo of a racehorse striding for the finish line.

“I thought they were giving me a horse,” he recalled, the shock still evident in his voice. “The first thought that ran through my head was ‘My wife is going to kill me’ because we have nowhere to put a horse.”

The McDaniels quickly explained that they were the horse’s owners and had named it Dr. Zic in honor of their physician.

“I really didn’t know what to say. You’re always honored when a patient even brings in a case of peaches from their farm or cookies for the staff. But this is really on a different level,” said Zic, associate professor of Dermatology at Vanderbilt University Medical Center and associate dean of admissions at Vanderbilt University School of Medicine.

Since learning about the namesake, Zic’s family and colleagues have followed the horse closely, making it necessary to use distinctions like “Dr. Zic, the horse” and “Dr. Zic, the man.” It helps that Dr. Zic is a chestnut filly, meaning the equine Dr. Zic is not a he, but a she.

When naming a racehorse, the owners usually play on a variation of a famous horse in its lineage or give it a family name. Several of the horses on the McDaniel’s farm are named mostly for grandchildren—Riki McD, Julia’s Star, Benny Boy, Princess Nadia and Bad News Sophia (because “bad news travels fast”). But Roger had always admired Dr. Fager, a famous racehorse from the 1960s, and wanted to do a similar name. The short, snappy “Zic” was the perfect fit.

“I’m honored that the McDaniels would name such a beautiful horse after me, and it’s been fun to watch the horse perform and race,” Zic said. “I grew up on the south side of Chicago. The closest thing to horseracing was an off-track betting facility four miles from my house, but this has certainly tweaked my interest.”

Zic said many patients from Kentucky have brought a newspaper with race results to their clinic visit, wondering if their doctor owns a racehorse. His roommates from college also noticed there was Dr. Zic running in a race on Kentucky Derby day and sent e-mails to inquire.

“I still don’t think they believe my patients named their horse after me,” he said ruefully.

A scary diagnosis

The McDaniels are both from Lexington, Ky., the Mecca of horseracing, but are relatively new to the business. Roger was in the electronics industry and the family lived all over the country, but it had always been his dream to own a horse farm back in Lexington.

“We had no experience whatsoever, but my husband is a businessman. Before we even bought the farm, he did a business plan just like he would do with anything else,” Beth said, and in 2005, Derby Lane Farm was born.

Around the same time, Beth began to have mysterious itching on her trunk. She saw specialists around the country, but no one could find a solution.

“They said maybe I’m allergic to type-26 blue dye or propylene glycol. It just went on and on and on,” she said. “Then I moved to Lexington, and it got really bad—the itching and redness and infection. Here I was moving into a new neighborhood and I wanted to hide.”

Finally a doctor in Lexington referred her to Zic who made the diagnosis—cutaneous lymphoma. In this relatively rare cancer, T or B lymphocyte cells (white blood cells) become cancerous and infiltrate the skin.

Beth’s cancer was at stage 4, and she needed to begin treatment immediately, but first had to choose where. On the recommendation of her daughter-in-law’s godfather, a director at the National Cancer Institute, Beth came to Vanderbilt to see Zic.

“He told me Dr. Zic was one of the top three people in the world and reasonably close to me, so this would be the perfect place,” she said.

Later when their trainer Joan Scott suggested the McDaniels purchase a promising filly she found in Florida, they knew just who to name her after.

A gift from the winner’s circle

Dr. Zic surprised everyone by winning her very first race at Keeneland under jockey Calvin Borel, a three-time Kentucky Derby winner. And she just kept winning.

“Dr. Zic won quite a bit of money, and my husband wanted to get me something for my birthday. I kept saying I have everything I want, so he came up with the idea that we would give to Vanderbilt,” Beth said.

Their gift was split in half between a fund for immediate use and an endowment so the funding opportunities will continue in the future.

The funds support cutaneous lymphoma research, including the work of two new Dermatology faculty members, Laura McGirt, M.D., and Jeffrey Zwerner, M.D., Ph.D., who are chomping at the bit to research the disease.

“There have been great strides in diagnosing the disease earlier and some significant discoveries in new treatments but we need more,” Zic said. “Patients with advanced disease are at higher risk for developing serious infections, and as with most cancers, the more advanced the disease, the fewer options we have to help those patients.”

Zwerner has a special interest in the pathologic markers that might predict outcomes in patients with cutaneous lymphoma, while Zic focuses more on clinical outcomes research. McGirt will be spending the majority of her time doing bench top research in the immunology and genetics of cutaneous lymphoma.

“I think the three of us together will complement each other’s interests and hopefully will lead to some exciting discoveries. The timing really couldn’t be better with two new faculty joining the division,” Zic said.

“It really shows how generous the McDaniels are. They are not just interested in helping themselves but in helping others by giving Vanderbilt researchers the resources they need to make discoveries.”

“My thinking is that it probably won’t help me,” Beth said, “but maybe my kids might have this disease and it would help them. I don’t want anybody else to go through this misery.”

Cutaneous lymphoma is a broad term that encompasses many variants. They typically present with a chronic rash in a sun-protected area, as opposed to most skin cancers, which present in a sun-exposed area. The rash can resemble eczema or psoriasis, which is why it can take as many as six to 10 years to get a diagnosis. Approximately nine patients per million per year develop the disease.

“The hallmark of this disease is that you itch to death,” Beth said. “My skin is often red all over and it dries and peels constantly. I feel as if I have full-body dandruff.”

Treatments include chemotherapy agents that are mixed in ointments and applied to the skin and phototherapy that bathes the patient’s skin in ultraviolet light.

When the cancerous cells enter the bloodstream, treatment progresses to photopheresis, which is what Beth undergoes once a month in addition to traditional chemotherapy. The patient’s blood is circulated through a machine that bathes it in ultraviolet light, which causes some lymphocytes to die. As the dying cells are infused back into the body, it triggers an immune response and the malignant cells are killed off.

A wonderful horse

With her treatment under way, Beth is now focused on overcoming a surprising fear—horses.

“When we first bought the farm I wouldn’t even pat the horses. You always hear about them biting and kicking,” Beth said.

But Dr. Zic is changing that.

“She is just so gentle and sweet and is such a wonderful horse. I’ll go to the barn to pat her and she’ll nuzzle me.”

Now Beth is taking riding lessons with the goal to one day ride in a show.

After her initial burst of success, Dr. Zic had to be taken out of racing for nearly a year after an operation to repair an ankle injury. Now she is in great shape, and won a Grade I stakes race at Keeneland this spring, upsetting favorite Informed Decision, who was undefeated in seven races on synthetic surfaces. (Grade I stakes are the most prestigious races, on par with the Kentucky Derby and Belmont Stakes.)

The McDaniels have pledged future winnings from Dr. Zic to the cutaneous lymphoma research fund.

“Dr. Zic may never win another race in her life, but we plan on adding to the fund when she does,” Beth said.

“It’s such an honor to have this recognition by one your patients, but it’s also very humbling,” Zic said. “I still smile whenever someone mentions it.”

And now he knows exactly what to do with a gift horse—watch it round the final turn and race for the finish, cheering all the way.

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